Anchor delivery system

ABSTRACT

The present disclosure relates to an anchor delivery system. The system includes a guide and an anchor delivery tool disposed within the guide. The tool includes a shaft and a handle coupled to a proximal portion of the shaft. The handle includes a hub and a nose cone coupled to the hub. In an embodiment, the tool further includes a knob coupled to the hub and located between the handle and the nose cone. In an embodiment, the system further includes an anchor, such as a suture anchor, coupled to a distal portion of the shaft. An anchor delivery tool and a method of repairing soft tissue are also disclosed.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Application No.60/824,573, filed Sep. 5, 2006. The disclosure of this prior applicationis incorporated by reference in its entirety.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present disclosure relates to methods and devices for use insurgical procedures and, more specifically, to an arthroscopic methodand apparatus for installing a suture anchor into bone.

2. Related Art

Medical devices and methods for attaching soft tissue to bone have beendeveloped. Of particular interest, especially in sports medicineprocedures, are suture anchors. A suture anchor is typically insertedinto and fixed in a bore hole drilled into a bone at a surgical repairsite. Sutures are typically coupled to the anchor and are used to securethe soft tissue to the bone in order to effect the repair. For manyrepair procedures, accuracy in the placement of suture anchors in boneis required to achieve consistently positive surgical outcomes,requiring substantial skill on the part of the surgeon.

Accurate placement of bore holes and suture anchors can be particularlychallenging when repair is performed arthroscopically, as both access toand visibility of an arthroscopic surgical site may be more limited thanis the case with open surgical procedures. For example, accuratelydrilling bore holes and placing suture anchors into these holes, atcertain joint areas of the body, can be difficult for even a veryexperienced surgeon. This is due to the delivery devices not being ableto reach a preferred anchor delivery point, not being able to achievethe preferred anchor trajectory, or both. In addition to these accessand visualization problems, current devices used in the delivery ofsuture anchors cannot withstand the forces imposed by new techniques.

With the increasing popularity of arthroscopic repairs on the shoulderand hip, as well as repairs in other body joints including the ankle,knee, elbow, and foot, surgeons increasingly need to perform theseprocedures accurately and repeatably.

Accordingly, a need exists for devices and methods that provide for theaccurate placement of suture anchors used in arthroscopic surgicalprocedures.

SUMMARY OF THE INVENTION

An aspect of the present disclosure relates to an anchor deliverysystem. The system includes a guide and an anchor delivery tool disposedwithin the guide. The tool includes a shaft and a handle coupled to theshaft. The handle includes a hub and a nose cone coupled to the hub. Inan embodiment, the tool further includes a knob coupled to the hub andlocated between the handle and the nose cone. In another embodiment, thesystem further includes an anchor, such as a suture anchor, coupled to adistal portion of the shaft. In yet another embodiment, a shaft of theguide is bent relative to a longitudinal axis of the guide. In a furtherembodiment, the anchor delivery guide includes a high strength material.

In another aspect, the present disclosure relates to an anchor deliverytool. The tool includes a shaft and a handle coupled to the shaft. Thehandle includes a hub and a nose cone coupled to the hub. In anembodiment, the tool further includes a knob coupled to the hub andlocated between the handle and the nose cone. In an embodiment, thehandle includes at least one suture retaining feature, such as a tab. Inanother embodiment, the handle includes multiple suture retainingfeatures. In yet another embodiment, the handle includes a throughpassage extending a length of the handle. In a further embodiment, theknob is movable between a first position and a second position withrespect to the nose cone. In yet a further embodiment, the knob isspring-loaded against the nose cone. In another embodiment, the knobincludes laterally extending wings. In yet another embodiment, the nosecone includes a cavity wherein the cavity houses a distal portion of theknob when the knob is in a first position. In a further embodiment, theshaft includes an area of reduced diameter, wherein a length of the areais about 3 mm. In yet a further embodiment, the shaft includes at leasttwo channels extending a length of the shaft. In another embodiment, theshaft includes a tip, the tip extending from a distal portion of theshaft.

In yet another aspect, the present disclosure relates to a method ofrepairing soft tissue. The method includes providing a guide; providingan anchor delivery tool, the tool including a shaft and a handle coupledto the shaft, the shaft including a suture anchor coupled to a distalend of the shaft, the handle including a hub and a nose cone coupled tothe hub; introducing the guide into a body; advancing the tool throughthe guide; placing the anchor in bone; and securing the tissue to thebone with the suture.

In an embodiment, the method further includes a knob coupled to the huband located between the handle and the nose cone. In an embodiment, themethod includes introduction of the guide into the body occurring in apercutaneous manner via the use of an obturator, such as a cannulatedobturator. In another embodiment, full advancement of the tool into theguide is obtained when a distal portion of the nose cone abuts aproximal portion of the guide. The distal portion of the nose cone andthe proximal portion of the guide are flat. In yet another embodiment,full advancement of the tool into the guide is obtained when a lasermark at a distal portion of the tool is centered in an opening at adistal portion of the guide. In a further embodiment, a proximal portionof the anchor is located about 3 mm below a surface of the bone when adistal portion of the nose cone abuts a proximal portion of the guide.In yet a further embodiment, a proximal portion of the anchor is locatedabout 3 mm below a surface of the bone when a laser mark at a distalportion of the tool is centered in an opening at a distal portion of theguide. In another embodiment, the tool is located at an angle of about90 degrees relative to the bone upon placement of the anchor in thebone. In yet another embodiment, the tool is located at an angle of lessthan about 90 degrees relative to the bone upon placement of the anchorin the bone. In a further embodiment, the tool is located at an angle ofmore than about 90 degrees relative to the bone upon placement of theanchor in the bone.

Further areas of applicability of the present disclosure will becomeapparent from the detailed description provided hereinafter. It shouldbe understood that the detailed description and specific examples, whileindicating the preferred embodiment of the present disclosure, areintended for purposes of illustration only and are not intended to limitthe scope of the present disclosure.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and form a part ofthe specification, illustrate the embodiments of the present disclosureand together with the written description serve to explain theprinciples, characteristics, and features of the disclosure. In thedrawings:

FIG. 1 shows an isometric view of the guide of the present disclosure.

FIG. 1A shows an enlarged view of a distal portion of the guide of FIG.1.

FIG. 2 shows an isometric view of a first alternative embodiment of theguide of FIG. 1.

FIG. 3 shows an isometric view of a second alternative embodiment of theguide of FIG. 1.

FIG. 3A shows an enlarged view of a distal portion of the guide of FIG.3.

FIG. 4 shows a side view of the guide of FIG. 3.

FIG. 5 shows an isometric view of a third alternative embodiment of theguide of FIG. 1.

FIG. 5A shows an enlarged view of a distal portion of the guide of FIG.5.

FIG. 6 shows a side view of the guide of FIG. 5.

FIG. 7 shows an isometric view of the anchor delivery tool and anchor ofthe present disclosure.

FIG. 7A shows an enlarged view of a distal portion of the anchordelivery tool and anchor of FIG. 7.

FIG. 8 shows an isometric view of the anchor delivery system of thepresent disclosure.

FIG. 8A shows an enlarged view of a distal portion of the anchordelivery system of FIG. 8.

FIG. 9 shows a cross-sectional view of the anchor delivery system of thepresent disclosure.

FIG. 9A shows an enlarged view of the nose cone and the knob of theanchor delivery system of FIG. 9.

FIG. 10 shows an isometric view of an obturator of the presentdisclosure.

FIG. 10A shows an enlarged view of a distal portion of the obturator ofFIG. 10.

FIG. 11 shows an isometric view of an alternative embodiment of theobturator of FIG. 10.

FIG. 11A shows an enlarged view of a distal portion of the obturator ofFIG. 11.

FIG. 12 shows a side view of an alternative embodiment of the obturatorof FIG. 10.

FIG. 12A shows an enlarged view of a distal portion of the obturator ofFIG. 12.

FIG. 13 shows an isometric view of a drill bit of the presentdisclosure.

FIG. 13A shows an enlarged view of a distal portion of the drill bit ofFIG. 13.

FIG. 14 shows a side view of anchor delivery into a bone by the anchordelivery system of FIG. 8.

FIG. 15 shows a side view of an alternative anchor delivery into a boneby the anchor delivery system of FIG. 8.

DETAILED DESCRIPTION OF THE EMBODIMENTS

The following description of the preferred embodiment(s) is merelyexemplary in nature and is in no way intended to limit the disclosure,its application, or uses.

FIG. 1 shows a guide 10 of the present disclosure. The guide 10 includesa shaft 11 coupled to a handle 12. A central passage 13 extends throughthe shaft 11 and the handle 12 for receiving a drill and an anchordelivery tool, as described in more detail below. The shaft 11 includesa proximal portion 11 a and a distal portion 11 b. The distal portion 11b, shown in FIG. 1A, includes a V-shaped tip 14 and an open side window15. For the purposes of this disclosure, there are two open side windows15 formed on opposite sides of the shaft 11. However, there may be moreor less than two. In addition, the windows 15 are located as distal aspossible as the space to view them arthroscopically is small in somejoints, such as the hip. Although, the windows 15 may be located more orless distal. The proximal portion 11 a is coupled to the handle 12 andpartially extends a length of the handle 12. The handle 12 includes abody 12 a, a tapered distal portion 12 b, and a flat proximal portion 12c. Having a flat proximal portion 12 c allows a surgeon to visualize thedepth that a drill and anchor are advanced into bone, therebysubstantially reducing the possibility of parallax and other depthcontrol issues that may be found in other designs, as further describedbelow. Similarly, having a tapered distal portion 12 b allows a surgeonto impart deeper penetration of the guide 10 into a body, if needed,during surgery, as will be further described below. The distal 12 b andproximal 12 c portions may be of a shape other than tapered or flat. Thebody 12 a includes circumferentially extending ribs 16 along a length ofthe body 12 a for maintaining a grip on the handle 12 while impartingaxial compression and bending into the guide 10 during surgery, as willbe further described below. However, other means for maintaining a grip,known to one of ordinary skill in the art, may be used. The guide 10also includes a longitudinal axis 17 along its length.

For the purposes of this disclosure, the guide 10 includes a highstrength material, such as a high strength stainless steel material, inorder to substantially reduce the possibility of plastic deformation ofthe guide 10 when it is subjected to various bending forces duringsurgery, as will be further described below. However, other highstrength material known to one of ordinary skill in the art can be used.

FIG. 2 shows an alternative embodiment of the guide 10 of FIG. 1 whereinthe shaft 11 of the guide 10 is bent or curved relative to thelongitudinal axis 17 of the guide 10. The bend or curve is incorporatedinto the shaft 11 to direct the drill and an anchor on the anchordelivery tool around anatomy during surgery, especially anatomy thatprevents a straight trajectory.

FIGS. 3 and 4 show an alternative embodiment of the guide 10 of FIG. 1.Specifically, the distal portion 21 b of the guide 20, as more clearlyshown in FIG. 3 a, includes a forked tip 24 and an open side window 25.Similarly, FIGS. 5 and 6 show another alternative embodiment of theguide 10 of FIG. 1. Specifically, the distal portion 31 b of the guide30, as more clearly shown in FIG. 5A, includes a crown-shaped tip 34 andopen side windows 35. Other shapes may be used for the tip of the distalportion of the shaft.

FIG. 7 shows the anchor delivery tool 40 and anchor 45 of the presentdisclosure and FIGS. 8 and 9 show the anchor delivery system 50 of thepresent disclosure. The tool 40 includes a shaft 41 and a handle 42coupled to the shaft 41. The shaft 41 includes a proximal portion 41 aand a distal portion 41 b. The distal portion 41 b, as more clearlyshown in FIG. 8 a, includes an area of reduced diameter 43 and a tip 44that extends from the distal portion 41 b. The area of reduced diameter43 includes a length of about 3 mm and is used for depth stop and reliefpurposes, as will be further described below. As shown in FIG. 7A, alaser mark 41 c is also located at the distal portion 41 b of the anchordelivery tool 40 for depth control purposes, as will be furtherdescribed below.

As also shown in FIG. 7A, a suture anchor 45 is coupled to the tip 44 ofthe tool 40. The anchor 45 includes an anchor body 45 a having ananchoring portion 45 b and a plug portion 45 c. The anchoring portion 45b includes at least two slots 45 d, extending a length of the anchoringportion 45 b, and laterally extending barbs 45 e. The plug portion 45 cincludes a passage 45 f that extends through the plug portion 45 c. Asuture 46, having two free ends 46 a, is disposed within the passage 45f such that both ends 46 a are housed within the slots 45 d of theanchoring portion 45 b, as shown by the arrow 45 h pointing to the slots45 d. The tip 44 interfaces with an opening (not shown) in a proximalportion 45 g of the anchor 45. The anchor 45 is more fully explained inU.S. Provisional Patent Application 60/896,520, which is incorporatedherein by reference in its entirety. The shaft 41 also includes twochannels 47 that extend from the area of reduced diameter 43 to theproximal portion 41 a. For suture management purposes during surgery,the two free ends 46 a of suture 46 extend along a length of both theanchor 45 and the shaft 41, are housed in the slots 45 d and channels47, and extend through a proximal portion 42 e of the handle 42.

As more clearly shown in FIG. 9, the proximal portion 41 a of the shaft41 is coupled to the handle 42. The handle 42 includes a hub 42 a, anose cone 48 coupled to the hub 42 a, and a knob 49 coupled to the hub42 a and located between the nose cone 48 and the handle 42. The handle42 further includes two suture retaining features 42 b, or tabs, forretaining suture 46 during surgery, as will be further described below,laterally extending ribs 42 c for maintaining a grip on the handle 42while imparting axial compression during surgery, and a through passage42 d. The nose cone 48 includes a flat distal portion 48 a, a proximalportion 48 b, and a cavity 48 c. In addition, the nose cone 48 includesa slotted opening 48 d for housing suture during surgery, as will befurther described below, and a bore 48 e. The bore 48 e is sized suchthat the nose cone 48 tightly fits the hub 42 a. The knob 49 includes adistal portion 49 a that is housed within the cavity 48 c when thedistal portion 49 a is in a first position, as shown in FIGS. 7-9 and aswill be further described below, a proximal portion 49 b, laterallyextending wings 49 c, and a bore 49 h. The bore 49 h is sized such thatthe knob 49 easily slides on the hub 42 a. In addition, as shown moreclearly in FIG. 9A, the knob 49 also includes a cavity 49 d that housesa spring 49 e for spring loading of the knob 49 against the nose cone 48and for adjusting the knob 49 between a first position 49 f, asdescribed above, and a second position 49 g, as more clearly shown inFIG. 9A.

As shown in FIG. 7, once the two free ends 46 a of the suture 46 areextended through the handle 42, the ends 46 a may be wound around thetabs 42 b of the handle 42, as represented by the arrows 42 b′, andsubsequently placed within the slotted opening 48 d to be retainedbetween the knob 49 and the nose cone 48 during delivery of the anchor45 into bone, as will be further described below.

FIG. 10 shows an obturator 60 that may be used for percutaneousintroduction of the guide 10 into the body. The obturator 60 includes ashaft 61 coupled to a handle 62. The shaft 61 includes a proximalportion 61 a and a distal portion 61 b. As shown more clearly in FIG.10A, the distal portion 61 b includes a conical, atraumatic tip 61 c foreasier passage of the obturator 60 through the body. Also shown in FIG.10A is a through passage 61 d that extends a length of the shaft 61 andis coaxial with a through passage 62 a that extends a length of thehandle 62. In use, the obturator 60 is inserted through the centralpassage 13 of the guide 10 and the combination is then passed over apreviously implanted guide wire to be introduced into the body anddelivered to the desired site for tissue repair. After delivery of theguide 10 into the body, the guide wire is removed. The obturator 60allows for easier percutaneous introduction of the guide 10 to a desiredsite within the body by filling the inner diameter of the centralpassage 13 and substantially reducing the possibility of the tip 14 frombecoming caught on tissue within the body.

FIGS. 11 and 12 show alternative embodiments of the obturator 60 of FIG.10. Specifically, the obturators 70,80 do not include through passagesextending the lengths of the shafts 71,81 and the handles 72,82. Similarto the tip 61 c of the obturator 60 of FIG. 10, the tip 71 c of theobturator 70 of FIG. 11 has a conical, atraumatic shape, as more clearlyshown in FIG. 11A. However, the obturator 80 of FIG. 12 has a sharp,pointed tip 81 c, as more clearly shown in FIG. 12A. Unlike theobturator 60 of FIG. 10, the obturators 70,80 of FIGS. 11 and 12 are notused for percutaneous introduction of the guide 10 into the body.Rather, obturators 70,80 are used for introduction of the guide 10through the seal of a previously implanted cannula and subsequently intothe body and to a desired site for tissue repair.

Once the obturator/guide combination reaches the desired site, the tip14 of the guide 10 is placed against the bone to stabilize the guide 10,for subsequent drilling and anchor delivery, and the obturator 60 isthen removed from the central passage 13 of the guide 10.

FIG. 13 shows a drill bit 90 that may be used for drilling of a holeinto a bone. The drill bit 90 includes a shaft 91 having a proximalportion 91 a and a distal portion 91 b. As more clearly shown in FIG.13A, a sharp, pointed tip 92 extends from the distal portion 91 b of theshaft 91. In addition, a laser mark 91 c is also located at the distalportion 91 b of the drill bit 90 for depth control purposes, as will befurther described below. The proximal portion 91 a includes a depth stop93 and an attachment area 91 d for coupling of a drive unit (not shown)used to rotate the drill bit 90 and drill a hole into bone. Afterinsertion of the guide 10 into the body and subsequent removal of theobturator 60 from the guide 10, the drill bit 90 is inserted into thecentral passage 13 of the guide 10 and a drive unit (not shown) iscoupled to the attachment area 91 d. The drive unit is then operated torotate the drill bit 90 and drill a hole into the bone. The laser mark91 c and the depth stop 93 cooperate to control the depth of the holesuch that the depth stop 93 abuts the flat proximal portion 12 c of theguide handle 12 at the same time that the laser mark 91 c becomescentered within the side windows 15 of the shaft 11. At this time, fulladvancement of the drill bit 90 into the guide 10 has occurred, drillingof the hole is finished, and the drill bit 90 is removed from thecentral passage 13 of the guide 10.

Subsequent to removal of the drill bit 90 from the guide 10, the anchordelivery tool 40 is disposed within the central passage 13 of the guide10, as shown in FIGS. 8 and 9, for delivery of the anchor 45 into thepreviously-drilled hole 100, as shown in FIG. 14. The anchor 45 isadvanced into the hole 100 in an axially-oriented manner by tapping on aproximal portion 42 e of the handle 42. Similar to the drillingprocedure described above, full advancement of the tool 40 into theguide 10 is achieved when the flat distal portion 48 a of the nose cone48 abuts the flat proximal portion 12 c of the guide handle 12. At thissame time, the laser mark 41 c is centered within the side windows 15 ofthe shaft 11. The distal portion 48 a of the nose cone 48 and theproximal portion 12 c of the guide handle 12 are both flat in order tosubstantially reduce the visualization problems, such as parallax, andthe resultant interpretation that is currently required for determiningdrill and anchor bone depths.

When full advancement occurs, the proximal portion 45 g of the anchor 45is positioned a distance d of about 3 mm below a surface 201 of the bone200. FIG. 14 shows the tool 40 located at an angle α, about 90°,relative to the surface 201 of the bone 200 upon placement of the anchor45 into the bone 200. However, as also shown in FIG. 15, the tool 40 maybe located at an angle of less or more than about 90 degrees relative toa surface 201 of the bone 200, as represented by arrows 300,400, uponplacement of the anchor 45 in the bone 200, and still deliver the anchorinto the bone such that the proximal portion 45 g of the anchor 45 ispositioned a distance of about 3 mm below a surface 201 of the bone 200.As described above, the distal portion 41 b of the shaft 41 includes anarea of reduced diameter 43 having a length of about 3 mm. The area 43is included on the distal portion 41 b to substantially reduce thepossibility of the distal portion 41 b from getting stuck in the hole100 of the bone 200 during delivery of the anchor 45 into the hole 100.However, the area 43 can also serve as a depth stop, especially when thenose cone 48 is not used, to ensure that the proximal portion 45 g ofthe anchor 45 is positioned a distance of about 3 mm below a surface 201of the bone 200.

Once the anchor 45 has been delivered into the bone 200, the two freeends 46 a of suture 46 are released from between the knob 49 and thenose cone 48 by moving the knob 49 toward the handle 42 and into asecond position 49 g, as shown in FIG. 9. The anchor delivery system 50is subsequently removed from the body, thereby leaving the anchor 45 andsuture 46 in the bone. The suture 46 is then used to secure a tissue tothe bone 200.

For the purposes of this disclosure, the anchor 45 includes abioabsorbable polymer material. However, the anchor 45 may be made froma biocompatible metal material, such as titanium. In addition, the shaft41 and the through passage 42 d are sized such that the shaft 41 ispress-fit into the through passage 42 d. Those of ordinary skill in theart would understand that the shaft 41 and the handle 42 may beassembled in other ways. As examples, the shaft 41 and the handle 42 maybe assembled by heat staking, ultrasonic staking, spin welding, insertmolding, or other methods known to one of ordinary skill in the art. Theshaft 41 includes stainless steel, but may be made from anotherbiocompatible material known to one of ordinary skill in the art. Alsofor the purposes of this disclosure, the handle 41 may include less thanor more than two suture retaining features 42 b. In addition, thefeatures 42 b are integral with the handle, but may be a separatecomponent, and may be of any number of geometric shapes.

The nose cone 48 is insert molded to the shaft 41. In this case, the hub42 a is placed in a mold and the nose cone 48 is molded around the hub42 a. Those of ordinary skill in the art would understand that the nosecone 48 may be coupled to the hub 42 a by heat staking, ultrasonicstaking, spin welding, or by any other method known to one of ordinaryskill in the art. In addition, the nose cone 48, knob 49, sutureretaining features 42 b, and handle 42 include a non-metal material, butmay include a metal material or other biocompatible material known toone of ordinary skill in the art. Also, the laser marks 41 c,91 c may beany other type of visible mark and may be of a variety of widths.

The shafts 61,71,81 and handles 62,72,82 of the obturators 60,70,80 aremade from stainless steel and plastic, respectively. However, either onecould be made from any other biocompatible material known to one ofordinary skill in the art. The shafts 61,71,81 are press-fit to theobturators 60,70,80, but could be coupled to the obturators 60,70,80 byany other method known to one of ordinary skill in the art. The drillbit 90 is made from stainless steel, but it could be made from any otherbiocompatible material known to one of ordinary skill in the art.

As various modifications could be made to the exemplary embodiments, asdescribed above with reference to the corresponding illustrations,without departing from the scope of the present disclosure, it isintended that all matter contained in the foregoing description andshown in the accompanying drawings shall be interpreted as illustrativerather than limiting. Thus, the breadth and scope of the presentdisclosure should not be limited by any of the above-described exemplaryembodiments, but should be defined only in accordance with the followingclaims appended hereto and their equivalents.

What is claimed is:
 1. A method of repairing soft tissue comprising:providing a guide; providing an anchor delivery tool, the tool includinga shaft and a monolithic handle, consisting of a handle portion and ahub portion, coupled to the shaft, and a nose cone coupled to the hub,the hub disposed within a bore of the nose cone, the shaft including asuture anchor coupled to a distal end of the shaft, suture extendingalong lengths of the anchor and the shaft and through a proximal portionof the anchor, the handle portion including suture retaining tabs andthe nose cone including a slotted opening, ends of the suture retainedby the tabs and the slotted opening; introducing the guide into a body;advancing the tool through the guide; placing the anchor in bone; andsecuring the tissue to the bone.
 2. The method of claim 1 furthercomprising a knob coupled to the hub, the hub disposed within a bore ofthe knob, the knob located between the handle and the nose cone, theknob movable along the hub.
 3. The method of claim 1 whereinintroduction of the guide into the body occurs in a percutaneous mannervia the use of an obturator.
 4. The method of claim 3 wherein theobturator is cannulated.
 5. The method of claim 1 wherein fulladvancement of the tool into the guide is obtained when a distal portionof the nose cone abuts a proximal portion of the guide.
 6. The method ofclaim 5 wherein both the distal portion of the nose cone and theproximal portion of the guide are flat.
 7. The method of claim 1 whereinfull advancement of the tool into the guide is obtained when a lasermark at a distal portion of the tool is centered in an opening at adistal portion of the guide.
 8. The method of claim 1 wherein a proximalportion of the anchor is located below a surface of the bone once theanchor is placed in the bone.
 9. The method of claim 1 wherein aproximal portion of the anchor is located below a surface of the bonewhen a distal portion of the nose cone abuts a proximal portion of theguide.
 10. The method of claim 1 wherein a proximal portion of theanchor is located below a surface of the bone when a laser mark at adistal portion of the tool is centered in an opening at a distal portionof the guide.
 11. The method of claim 1 wherein the tool is located atan angle relative to the bone upon placement of the anchor in the bone.12. The method of repairing soft tissue of claim 1 wherein a shaft ofthe guide is bent relative to a longitudinal axis of the guide.